Guest interview
Don’t miss this month’s guest interview with Justene Ewing, CEO Digital Health and Care Institute: Could Scottish SME’s conquer the digital health world.
News in brief
Regulator chief tells hospital trusts to do more with existing technology: An executive director of health service regulator Monitor has said hospital trusts can improve efficiencies through the use of their existing technology, rather than waiting for a burst of investment, reported Digital by Default. Adam Sewell-Jones, the health watchdog’s first ever executive director of provider sustainability, said that the use of computer systems is the key focus in his drive to streamline services. He said: “Without more capital investment we could be driving more out of the technology we have available.” The director said there were plenty of options for trusts seeking to hit tough savings targets and dismissed the opinions of hospital chief executives who complained earlier this year that they could not do any more to improve efficiency. He commented: “There is more we can do. But it’s really hard and I can’t say to people, ‘Of course you can do it, because look what I did’, because the fact is it’s hard graft. I suspect if you went on to many wards now you’d find jobs that a lower level admin member of staff could be doing but you’ve got a senior nurse who is sat in the office doing it rather than delivering frontline care.”
Social care budget cuts bringing NHS services to breaking point – think tank: Cuts to social care budgets are adversely affecting health services, according to 88% of NHS trust finance directors and 80% of clinical commissioning group (CCG) finance leads, The King’s Fund has found. The think tank’s latest quarterly monitoring report analysed NHS performance data to find that more than 5,000 patients experienced discharge delays from hospital at the end of August, reported National Health Executive. This was the highest level at that time of year since 2007. Further analysis revealed that nearly one-third of these delays were caused by problems in accessing social care services, marking an increase of 21% in the past year. The King’s Fund therefore called on the government to protect the social care sector from further budget cuts, as well as reinvest the £6bn previously earmarked to implement the Dilnot reforms. The survey, carried out in September, also served to confirm that the NHS is now in serious financial crisis, given that it amalgamated data from two months after the period covered by recent reports from healthcare regulators. Speaking to BBC Radio 4’s PM programme, John Appleby, the Kings Fund economist said: “If we go back to the early 1950s we were spending something like 3% of GDP on the NHS and that went up to a high of nearly 8% of GDP in about 2009. Since then, austerity, government decisions about funding the NHS, has meant that as a share of GDP what we devote to the NHS has started to decline.”
Lord Carter: reducing variation in care could save NHS £5 billion: Hospitals can save around £5bn by reducing variation in care and improving the way they care for patients, Lord Carter said this week. The call is part of Lord Carter’s review into how savings can be made by the NHS, which aims to help local NHS chief executives make their hospitals safer and more efficient at the same time, reported Gov.UK. For the first time, the activity carried out by all NHS hospitals has been reviewed together and broken down by clinical speciality. The results have shown huge variations in clinical costs, infection rates, readmission rates, litigation payments and device and procedure selection. The review has highlighted the huge opportunity for hospitals to tackle these variations. 137 NHS acute hospital trusts (non-specialist) in England have received detailed plans that show how and where they can improve patient care and become more efficient. The £5 billion worth of savings has been broken down by speciality. The top 12 specialties include general medicine and cancer services. Lord Carter said: “Our best hospitals offer patients an excellent service and they are up there with the very best in the world and we want to make sure all NHS hospitals meet these high standards of care. The route to better care is to empower NHS leaders, so giving them the data and support they need means they can improve how they care for patients, make savings which can be reinvested in frontline care. Patients will be the real winners.”
Jeremy Hunt ‘misrepresented weekend deaths data’: The health secretary has misrepresented a key study used to back the case for more seven-day NHS care, reported the BBC. Dr Fiona Godlee has written to Jeremy Hunt about recent comments where, she said, he has implied the higher weekend death risk is due to poor staffing. The study has been repeatedly used by Hunt. The research was carried out by seven leading doctors and statisticians, including NHS England medical director Sir Bruce Keogh. In the letter to the health secretary, Dr Godlee said: “I am writing to register my concern about the way in which you have publicly misrepresented an academic article published in The BMJ. This clearly implies that you believe these excess deaths are avoidable. “Responding on behalf of Hunt, health minister Ben Gummer said: “Significant independent clinical evidence shows increased mortality in our hospitals at weekends linked to reduced clinical cover. The BMJ’s authors themselves acknowledge that – and any debate about precisely how many of the thousands of deaths are avoidable misses the point. What all doctors want is to provide the best care for their patients, and the public rightly expect the highest standards whichever day of the week they are admitted to hospital – the government is committed to supporting that.”
Scottish NHS is in critical condition say watchdogs: Scotland’s health service is buckling under “significant pressure” and will not be able to provide the same level of service in the future unless urgent action is taken to alleviate the strain it faces, according to a new report. The public spending watchdog, Audit Scotland, laid bare a litany of problems in its report, including tightening budgets, rising costs, higher demand for services, pressure to meet targets and increased staff vacancies, reported The Scotsman. Medical leaders called for “substantive action” to be taken in the wake of the publication, while opposition MSPs called it a “damning analysis” and accused the Scottish government of operating “a sticking-plaster approach” to problems within the NHS. The document, entitled NHS in Scotland 2015, warned that the NHS would not be able to continue providing its current level of service unless profound changes were made. The auditor general for Scotland, Caroline Gardner, said: “We have highlighted concerns around targets and staffing in previous reports. These have intensified over the past year as has the urgency for fundamental changes such as introducing new ways to deliver healthcare and developing a national approach to workforce planning. It is important that the Scottish government and health boards work closely together to help alleviate these pressures and also increase the pace of change necessary to meet its longer-term ambitions.”
Pharmacy hit with £130,000 fine for selling on patient data: A major online pharmacist has been fined £130,000 by the information commissioner for selling on the data of more than 20,000 patients to secondary marketing companies, which is likely to have resulted in patients having “suffered financially”, reported Pulse. The Information Commissioner’s Office (ICO) fined Pharmacy 2U for failing to inform customers of their intention to sell on their names and postal addresses through an online marketing list company, and for selling it without consent. While the company said medical details were not passed on, it has not been able to notify the customers affected because it ordered the “certified destruction” of their names when the breaches came to light. The breaches were partly identified as part of a Daily Mail investigation into list marketing companies targeting vulnerable individuals. The company “sincerely apologised” for the breach, and said that as soon as it was made aware of the breach it stopped the trial selling of customer data. ICO deputy commissioner David Smith said: “Patient confidentiality is drummed into pharmacists. It is inconceivable that a business in this sector could believe these actions were acceptable.”
Use £150m Challenge Fund to support existing out-of-hours care, say GPs: More than half of GPs believe the £150m Challenge Fund set up by Prime Minister David Cameron to support routine seven-day GP services would be better spent on existing out-of-hours primary care, a GPonline survey has shown. A total of 58% of more than 400 GPs who took part in the survey agreed that the Challenge Fund should be scrapped, and its funding diverted to pay for existing out-of-hours services. Last month the British Medical Association’s (BMA) blueprint for a new future for general practice also called for Challenge Fund cash to be used to support existing urgent care services. The BMA report criticised the government’s attempts to establish a ‘parallel routine service’ and demanded integration and better funding for urgent care. The report demanded the integration of urgent care across 111, GP out-of-hours and urgent care centres, with fixed minimum staffing levels for out-of-hours organisations. BMA leaders have warned that rolling out routine seven-day GP services similar to those in Challenge Fund areas across England could cost £1bn a year.
HMRC VAT rules cut cloud costs by 20% for NHS and government departments: HM Revenue & Customs (HMRC) will allow NHS and government departments to reclaim the VAT on off-premise purchases. In bowing to pressure from cloud-championing campaigners, HMRC unveiled a revamped version of its Contracted Out Services guidance, which sets out the range of outsourced services government departments and NHS bodies are entitled to reclaim VAT on. HMRC has added commodity cloud services to the list – meaning such services will cost 20% less for NHS bodies and government departments to procure as of October 2015. Former G-Cloud lead Mark Craddock welcomed the decision, having publicly criticised HMRC for excluding cloud services in the past. Craddock has been campaigning to have cloud services added to the list for four years. Speaking to Computer Weekly, Craddock said the ruling should make it easier for public sector organisations to make a business case for cloud services. “I did some cost models for on-premise and cloud, and the cost savings are close – but VAT was always the killer,” he said.
First GPSoC integrations live: Two subsidiary GP systems suppliers have integrated their systems with those of principal suppliers for the first time under the latest GP Systems of Choice (GPSoC) framework. NHS England said the interface mechanisms to allow the first integration of patient-facing services will now be finished by the end of this year. Medibooks from Total Billing Solutions has begun piloting in five Trans-Pacific Partnership (TPP) SystmOne GP practices, after getting full roll-out approval using the new Health and Social Care Information Centre(HSCIC) “pairing” process. When a new GPSoC contract was signed in March last year, it specified that principal system suppliers must provide interface mechanisms to allow suppliers of subsidiary services to integrate with them. This would open up the market and give greater choice to GPs for provision of systems such as document management and patient transactional services. NHS England’s senior responsible owner for GPSoC, Tracey Watson told DigitalHealth.net that a lot of the “teething problems” with the initial pairing process have been sorted out. This would be in line with Health Secretary Jeremy Hunt’s ambition to have a quarter of smartphone users routinely accessing NHS advice, services and medical records through apps by the end of the next financial year.
East Lancashire Hospitals NHS Trust and Caradigm collaborate to digitise nursing risk assessments: Caradigm has announced the completion of its implementation to digitise East Lancashire Hospitals NHS Trust’s nursing risk assessments forms, reported Building Better Healthcare. After successful implementation and use of the Caradigm Intelligence Platform, and digitisation of the trust’s pre-operative assessments within its orthopaedic outpatient’s clinic, the hospital set its sights on digitising, streamlining and making more intuitive seven paper-based nursing risk assessment forms used during patient admissions and throughout their stay in hospital. The nursing risk assessment forms were introduced to the hospital’s clinical staff through highly-positive user acceptance testing; and all of the trust’s seven nursing risk assessment forms are now live across its 36 wards, with 15,000 assessments being completed every month. Nurses are accessing the electronic assessments via a range of devices such as PCs, mobile devices, on battery carts, and bedside TV screens; and the trust is in the process of testing the software on tablets. Margaret Taylor, ward manager on the gynaecology and breast ward, said: “The previous risk assessment forms required nurses to manually calculate things like BMI and add up the score of the risk assessment. Now, the electronic forms are doing all of this for us and are proving to be a lot quicker to complete than when we were producing written data. I would say up to 50% more.”
Clinical research activity in NHS at all-time high: The amount of clinical research activity across the NHS in England is at an all-time high, the National Institute for Health Research (NIHR) Clinical Research Network has revealed, reported National Health Executive. The body’s 2014-15 league table, showed that more trusts are undertaking research studies than ever before, and more people are participating in them. The table, now in its fifth year, provides a picture of how much clinical research is happening across the NHS, from which doctors gather evidence about new treatments in order to improve patient care. Dame Sally Davies, England’s chief medical officer, said: “Yet again our world-class NIHR infrastructure has shown that it continues to grow and is providing exciting research projects to benefit our health service. High quality research is vital to bring new treatments to patients as quickly as possible and the clinical research network is proving to be a real success in driving forward this essential work.” Dr Jonathan Sheffield, the NIHR’s chief executive officer, added that, for the third consecutive year, more than 600,000 people took part in clinical research in England. Looking ahead, we will see an increasing number of trials with fewer patients needed in the trial to provide evidence of efficiency and effect.”
One million older people in need ‘struggle alone’: A million older people in England struggling with everyday tasks, such as washing and dressing, are being left to fend for themselves, campaigners said. The Age UK review identified more than 3m people aged over 65 with a care need, but found just two-thirds of them were actually getting help, reported the BBC. The charity warned that the lack of support for the ageing population was risking their health. But ministers said steps were being taken to provide more help. The review used official data and existing research to identify how many people were struggling with everyday tasks and how many were getting help. There are 10m people over the age of 65 in England, the review said, and more than 3m struggle with simple everyday tasks. Just over one million pay for care or rely on family and friends with another 850,000 supported by their local councils. However that leaves another one million who have to fend for themselves. The report also warned that community NHS services and GPs were struggling to meet demand from the ageing population. Age UK warned there were signs this was affecting the health of older people.
US health guru gets NHS England role: NHS England has recruited Dr Donald Berwick, a former senior health official under Barack Obama in the United States, to help develop new models of care across the country, reported Public Finance. Berwick, currently a senior fellow at the US-based Institute for Healthcare Improvement, will participate in a series of events organised with The King’s Fund think-tank to help the vanguard projects develop effective leadership for system transformation. Berwick’s role will include working with organisations across the NHS in order to support improvement of care, outcomes, and costs within the NHS in England. Samantha Jones, director of NHS England’s New Care Models programme, said: “The vanguards have asked us to support them in developing leadership capability and to help them learn from international experts. We’re delighted to have teamed up with The King’s Fund and Don to put this in place.”
Julie Moore to run two Birmingham FTs: Dame Julie Moore, the chief executive of University Hospitals Birmingham Foundation Trust, is to take over the leadership of its troubled neighbour Heart of England Foundation Trust (FT), Health Service Journal (subscription required) has learned. University Hospitals Birmingham’s chair Jacqui Smith will also become chair of Heart of England. However, the FTs will retain separate boards and will not merge. Bringing the leadership of the two organisations together would link five acute hospitals with a combined turnover of £1.4bn. Heart of England’s current chair Les Lawrence will step down at the end of November, after less than 18 months in post. Monitor has said Dame Julie has been brought in on an “interim” basis. However no end date has been given for her appointment. The move comes a year after Heart of England’s last permanent chief executive, Mark Newbold, resigned. Wrightington, Wigan and Leigh FT chief executive Andrew Foster served as interim chief for much of this year, but has not been appointed on a permanent basis.
Opinion
Building healthier accountable communities
Developing place-based systems of care and collaborating across organisational and service boundaries can help to meet the needs of a defined population, writes Nicola Walsh, assistant director, leadership at The King’s Fund, in a blog this week.
Describing one of three key areas that featured at a recent integrated care summit, Walsh says: “Many approaches are being developed; new system leadership groups are being established across counties, and in other places, such as Ilfracombe in Devon, a more local approach is being taken.
“All public services in the town have worked together and formed a not-for-profit organisation – One Ilfracombe. Over the past two years, the organisation has worked with local residents to achieve greater service integration and provide people with more support at the ‘wobble points’ in their lives to avoid a crisis.
“One Ilfracombe has three teams: the town economy team chaired by the chief executive of a large local employer; the town team chaired by the local police inspector and residents (focused on creating a cleaner, safer and greener town); and the living well team chaired by a local GP.
“The three teams are leading a range of activities to improve care co-ordination and tackle the broader determinants of health. Together staff and residents are developing a stronger local NHS – a neighbourhood health and wellbeing service.”
The government can’t talk its way out of the junior doctors standoff
The health secretary finds himself in a tight communications bind as the junior doctors’ cause attracts public and political sympathy says Mike Birtwistle, a founding partner at Incisive Health, a specialist health policy and communications consultancy.
“The rapid descent of discussions over the contract for junior doctors into a standoff will make politicians very nervous indeed. Juniors are not a group on six-figure salaries (yet), nor do they have gold plated pensions. Their lives are not too far removed from those of the many swing voters who ministers need to keep onside.
“A challenge for the government is that the public believes seven day working already occurs in hospitals. Hospitals do not empty out their beds on a Friday afternoon only to re-admit the same people for the same issue on a Monday morning. In this sense, the row is about solving a problem that the public didn’t know existed. There is no way to communicate your way out of this. The simple truth is that the government is asking juniors to do more for the same total level of resources. Try and change the working practices of any group in this way and you won’t get a very good reaction.
“It’s a tough situation for health ministers. They don’t have a great deal of public support or sympathy from colleagues elsewhere in government, yet they will be well aware that the current situation is causing anxiety and there is an expectation from Number 10 that they will resolve it. The strike over NHS pensions – which was unpopular and failed to make much of an impact – provides a salutary reminder of how difficult it is to organise industrial action that disrupts services, protects safety and doesn’t lose the goodwill of the public. Neither side will want the dispute to get that far.”
It’s time to hand over the keys to the GP record
Dr Jonathan Inglesfield argues GPs need to be more willing to share patient data, in a Pulse Today (subscription required) article this week.
“It’s not easy to change the habit of a professional lifetime.
“Confidentiality has been embedded in us since medical school and consolidated through years of clinical practice. The computerised clinical record is the physical manifestation of this confidentiality. Unsurprisingly we are reluctant to risk betraying the trust of our patients. We keep the data control keys well-guarded in our surgeries. The problem is that we can’t carry on like this. We need to change and accept the need to share access. If we don’t, not only will patients have more fragmented care but our lives as clinicians will be harder.
“As data controllers, GPs are able to enter into information sharing agreements with providers who are able, at speed and with moderate cost, to place primary-care systems within their own facilities. Locally we now have an EMIS terminal within our acute hospital accident and emergency department capable of viewing the entire primary care record of 20 of our 21 practices. The power of this tool in a hospital setting is immense – for the first time hospital clinicians offering emergency care are privy to the longitudinal view of the patient journey. Episodic care starts to become longitudinal.
“Of course safeguards are needed – robust data sharing agreements, a well-publicised fair processing notice and audits to ensure appropriate access. All this can be put in place quickly. We also need to refine how and what we record. Highly personal details of lives may become increasingly inappropriate in the record, but that applies as much to sharing within a large group practice as it does between healthcare providers.
“We need to see the default position as a requirement to share, balanced with assurance around safeguards, rather than one of declining to share because of confidentiality concerns. If we don’t share our patients will receive even more fragmented care, and our lives will be more difficult as we stay within ‘refer for opinion’ rather than shared care decision making.”
Highland Marketing guest interview
Scotland’s SMEs now have a real chance to seize the global digital health market, whilst meeting the needs of the NHS, Digital Health and Care Institute CEO Justene Ewing tells Susan Venables.
